AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON), AND MISHA GAREY, DDS
“New census estimates foretell profound demographic change for the country.” 1
INTRODUCTION
The majority of births in the United States are now by Hispanic, black and Asian mothers. It is evident that nationwide, white Americans will become a minority within about three decades and will “…be reliant on younger minorities and immigrants for our future demographic and economic growth.” 2
Decades of studies and reports based on race/ethnicity, income, residency locations and insurance have emphasized the disparities in the delivery of health care to the general public. The lay-out of most tables in these reports accentuates the use of services by non-Hispanic white middle and higher income populations with insurance.
The tables usually compare and recognize the inadequacies for the poor and minority populations.
HISPANICS: A DRAMATIC INCREASE IN POPULATION
In particular, the many reports on demographic changes emphasize the dramatic increases in the Hispanic population. “More than half of the growth in the total population of the United States between 2000 and 2010 was due to the increase in the Hispanic population.” 3
Hispanics are a diverse ethnic population, varying in race, origin, age, immigration status, and other characteristics. According to the 2010 Census, 308.7 million people resided in the United States on April 1, 2010, of which 50.5 million (or 16 percent) were of Hispanic or Latino origin. The Census Bureau projects that by the 2020 Census almost one-in-five residents of the country (63.8 million individuals) will be of Hispanic origin. (see Table 1)
BLACKS: LIMITED INCREASE IN POPULATION
The dramatic increase in the Hispanic population overshadows the gradual and limited increase in the black population 38.9 million residents in 2010 to a projected 43.6 million in 2025. Blacks represented 12.6% of the total national population in 2010 and projected to increase to 13.2% of the population in 2060. During the same period, the Hispanic representation of the total US population will increase from 16.3% to 30.6%. (see Table 1)
(Notes: Blacks who reported more than one race grew at a much faster rate than the black alone population. About 97% of the black alone population reported that they were non-Hispanic. The Black population grew in every state between 2000 and 2010, but declined in the District of Columbia.5)
DIFFERENCES IN THE PROPORTION OF CHILDREN WITH DISABILITIES
The increasing marked differences in the number of black and Hispanic children in the country should not mask the fact that in 2011 a greater proportion of black than Hispanic children were reported to have one or more severe disabilities (5.0% vs. 3.7%) (526,600 black vs. 643,100 Hispanic children less than 18 years).6
DIFFERENCES NUMBER AND PROPORTION AT THE STATE LEVEL
In 2011, there were an estimated 526,000 black children (5.0% of black children) with severe disabilities in the United States. At the state level (for which data are available) the number of black children with disabilities ranged from between 1,100 and 1,600 in Iowa, Oregon and Colorado to 36,900 in Florida, 37,200 in Georgia and 40,200 in Texas. The percent of black children with disabilities among all black children less than 18 years of age ranged from 3.1% and 3.9% in Colorado, Delaware, South Carolina and Iowa to 7.0% and 8.5% in Kansas, Oregon and Wisconsin. (see Table 2)
DIFFERENCES IN HEALTH DIFFICULTIES AT THE STATE LEVEL
Results from the 2011 National Survey of Children’s Health (based on reports by parents/guardians) indicate marked differences in the proportion of black children with special needs and range of health related issues in the states for which data are available. For example, the proportion with:
• Special needs ranged from 3.8% in Alaska to 24.5% in Alabama.
• Oral health problems ranged from less than 1% in North Dakota to 23% in Nevada.
• Extreme overweight (obese) ranged less than 1% in four states to 22% in Ohio.
• Chronic health conditions(s) ranged from less than 1% in Montana to 29% in the District of Columbia. (see Table 3).
ECONOMICS
The median wealth of white households is 20 times that of black households and 18 times that of Hispanic households, according to a Pew Research Center analysis of newly available government data from 2009. “These lopsided wealth ratios are the largest since the government began publishing such data a quarter century ago and roughly twice the size of the ratios that had prevailed between these three groups for the two decades prior to the Great Recession that ended in 2009.”8 The Pew Research analysis found that, in percentage terms, the bursting of the housing market bubble in 2006 and the recession that followed from late 2007 to mid-2009 took a far greater toll on the wealth of minorities than whites.8
While the majority of non elderly blacks are in working families, they are significantly more likely than whites to be poor. Overall, nearly two-thirds of non elderly blacks have a full-time worker in the family. However, the large majority of black workers (70%) are employed in blue-collar jobs that typically provide low wages and are less likely than white collar jobs to offer health insurance coverage. “Reflecting both lower full-time employment rates and higher concentrations of black workers in blue-collar jobs, blacks are two and half times more likely than whites to have family income below the poverty level.”9
Less than half of non elderly blacks have private coverage compared to over seven in ten non-Hispanic whites. Medicaid coverage helps fill some of the gap in private health insurance, covering nearly one in three of all non elderly blacks (32%). However, Medicaid does not fully offset the difference leaving more than one in five (21%) non elderly blacks uninsured, compared to 13% their white counterparts. Among those states for which data available, the uninsured rate among non elderly blacks ranges from 9% in Delaware to 30% in Louisiana.
• 38% of black and 67% of white children (< 19 years) are covered by private health insurance.
• 52% of black and 26% of white children are covered by Medicaid. Medicaid plays a much more limited role for black adults, leaving more than a quarter uninsured (26%).
• 11% of black and 7% of white children are uninsured for health services.9
Medicaid plays an important role in filling gaps in health coverage for most black children, including many black children with disabilities. The recently passed Affordable Care Act has the potential to increase health coverage and access to care for low-income uninsured blacks and as states decide whether to expand Medicaid, the stakes are especially high in states with a large number of uninsured blacks. In addition there is the reality of the reluctance of many health practitioners to participate in the Medicaid program.
COMMENTARY
The dramatic increases in the numbers of Hispanics in the national population, including Hispanic children with disabilities, may seem to overshadow the greater proportions of black children with their disabilities. But both populations (including the combination of Hispanic-black individuals) are constrained by similar economic difficulties, inadequate health insurance coverage, reluctance of practitioners to participate in government sponsored programs and the reality that health care providers may lack racial and cultural sensitivity and willingness to work with parents in their children’s health care.10
Ascendency of all minority populations, in particular the populations with disabilities, provides a need to maximize effort to improve access for oral health services for these individuals. “The proverbial roles of increasing ‘minority power’ and ‘minority practitioner role models’ are essential factors in: 1) developing legislative support for the needed health services of minority populations and 2) increasing the demand for all oral health care from providers with whom minority populations could identify.” 11 •
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail:h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) – Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Misha Garey, DDS is Director of Dental Services at the Orange Grove Center.
References
1. Roberts S. For whites, more deaths than births, data shows. NY Times, June 6, 2013. pA16.
2. Centers for Disease Control and Prevention. Health United States 2011. Available from:
http://www.cdc.gov/nchs/data/hus/hus12.pdf Accessed July 10, 2013.
3. Ennis SR, Rios-Vargas M, Albert NG. Census Bureau, Hispanic Population 2010. Available from:
http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf Accessed August 22, 2013.
4. U.S. Census Bureau. Population projections 2015-2060.
Accessed from: http://www.census/gov/population/projetions/files/summary/NP2012-T4.xls Accessed August 22, 2013.
5. Rastogi S, Johnson TD, Hoeffel EM, Drewery Jr. MP. Black Population 2010. Census Brief. Web site:
http://www.census.gov/prod/cen2010/briefs/c2010br-06.pdf Accessed August 27, 2013.
6. U.S. Census Bureau. American Community Survey. Web site:
http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml Accessed August 15, 2013.
7. Data Resource Center for Child and Adolescent Health. 2011 National Survey of Children’s Health. Web site: http://www.childhealthdata.org Accessed August 28, 2013.
8. Kochhar R, Fry R, Taylor P. Wealth gaps rise to record highs between whites, blacks, Hispanics. Pew Foundation. Web site: http://www.pewsocialtrends.org/2011/07/26/wealth-gaps-rise-torecord-highs-between-whites-blacks-hispanics Accessed August 28,2013.
9. Duckett P, Artiga S. Health coverage for the black population today and nder the Affordable Care Act. Kaiser Family Foundation. Web site: http://kff.org/disparities-policy/fact-sheet/health-coveragefor-the-black-population-today-and-under-the-affordable-care-act Accessed August 28, 2013.
10. Parish SL, Magaña S, Rose RA, Timberlake M, Swaine JG, Fichtenbaum R. Latino children with autism and other developmental disabilities experience disparities in access, utilization, and quality of health care. Brandeis University, The Heller School for Social Policy and Management. June 2011. Available from: http://lurie.brandeis.edu/pdfs/pb2-latinodisparaties.pdf Accessed August 28, 2013.
11. Waldman HB, Perlman SP. Use of oral health care and the need to expand the population that is served. NY State Dental Journal. In press
